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CC BY 4.0 · Thromb Haemost
DOI: 10.1055/a-2692-3064
Coagulation and Fibrinolysis

Clinical Characteristics and Prognosis of Sepsis Subphenotypes Identified by Coagulation Indicator Trajectories: A Single-Center Retrospective Study

Bo-yang Wang 
1   Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
,
Rong Liu-fu
1   Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
,
Run Dong
1   Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
,
Yan Chen
1   Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
,
Yao Wu
1   Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
,
Xiao-jun Zhao
1   Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
,
Ya-li Sun
1   Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
,
Bin Du
1   Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
,
Li Weng
1   Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
› Institutsangaben
Funding Information This study was supported by the National Key R&D Program of China (number: 2022YFC2304601), CAMS Innovation Fund for Medical Sciences (CIFMS) from Chinese Academy of Medical Sciences (2021-I2M-1-062), National Key Clinical Specialty Construction Projects from National Health Commission, National Key R&D Program of China from Ministry of Science and Technology of the People's Republic of China (number: 2021YFC2500801).
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Abstract

Background

This study aimed to identify new sepsis subphenotypes on the basis of coagulation indicator trajectories and comprise clinical characteristics and prognosis.

Patients and Methods

This retrospective study included patients diagnosed with sepsis admitted to the intensive care unit of Peking Union Medical College Hospital from May 2016 to March 2023. Using group-based trajectory models, we classified patients into different subphenotypes on the basis of the dynamic daily changes in coagulation parameters within the first 7 days after sepsis diagnosis. Clinical characteristics and outcomes of patients were compared between subphenotypes.

Results

A total of 3,990 patients diagnosed with sepsis were included in this research. Patients were divided into four trajectory groups on the basis of indicator trajectory: Group 1 (n = 500), with high prothrombin times (PTs) and rapidly increasing D-dimer levels; Group 2 (n = 1,334) had normal PT, mildly increasing D-dimer levels and platelet counts. Group 3 (n = 1,013), with mildly elevated PT and D-dimer levels, along with lower platelet counts and fibrinogen levels. Group 4 (n = 1,143) had mildly elevated PT and D-dimer levels along with elevated platelet and fibrinogen levels. Four trajectory subphenotypes exhibit different 28-day mortality, overall in-hospital mortality, bleeding and thrombosis incidence, and the rate of patients with mechanical ventilation.

Conclusion

Coagulation trajectory subphenotypes offer a novel approach for stratifying sepsis heterogeneity, identifying high-risk patients, and refining prognostic assessment. The subphenotype with rapidly rising D-dimer levels warrants heightened clinical vigilance due to its association with the poorest outcomes.

Keywords

sepsis - subphenotype - disseminated intravascular coagulation - D-dimer - group-based trajectory models

Data Availability Statement

The data utilized in this study can be accessed by the corresponding author on reasonable request.


Contributors' Statement

All the authors participated in the conceptualization and design of the study. Data collection and analysis, as well as the writing of the manuscript, were completed by B.Y.W. All the authors were involved in the research process and the revision of the manuscript. All the authors have read the final draft and agreed to its publication.


Ethics Approval

This study received approval from the Institutional Review Board at Peking Union Medical College Hospital. The approval included a waiver for the informed consent of the patients.


Supplementary Material



Publikationsverlauf

Eingereicht: 22. März 2025

Angenommen: 26. August 2025

Artikel online veröffentlicht:
09. September 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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